AB1414 THE COST OF PRENATAL CARE IN WOMEN WITH RHEUMATIC DISEASES.
Authors: M. E. Corral Trujillo, F. R. Arevalo Nieto, L. G. Espinosa Banuelos, C. M. Skinner Taylor, L. Pérez Barbosa, A. Y. Lujano Negrete, D. Á. Galarza-Delgado
Journal: Annals of the Rheumatic Diseases (2022)

Background In Mexico, over 60% of the population is uninsured and not able to afford private healthcare services. Women with autoimmune rheumatic diseases (ARDs) are a high-risk group during pregnancy. Morbidity associated with ARDs and pregnancy can include lower birth weight, increased preterm delivery, and more emergency cesarean sections than pregnant women without ARDs. Close monitoring and multidisciplinary care are necessary to prevent and timely treat complications, on the other hand these health interventions are not available to all women with ARDs because of the high prices that it represents. Objectives The aim of this study was to estimate the cost of prenatal care in women with ARDs without health insurance in Northeast Mexico. Methods To assess the costs of prenatal care of women with ARDs in the Northeast of Mexico from the perspective of a women without any health insurance, we estimated only the direct costs of the mandatory medical follow-up. Direct costs are all healthcare costs that are directly related to the consultations with a multidisciplinary team, serological and immune laboratory test, and ultrasounds per trimester. All costs and medical fees were obtained from a university hospital in Monterrey, Mexico. To assess the impact of prenatal care in real life, we compared the health expenditure per trimester reported by the pregnancy and rheumatic diseases clinic from the same institution. The data is presented in USD. We were not able to assess indirect costs related to health coverage (like transportation) and specific medical treatment (antirheumatic drugs or other interventions). Results The mean cost for medical consultations and ultrasounds per trimester was $184-277 USD. The average cost of immune test and general lab test ranges from $424-428 USD. The total cost per trimester was from $608 to 705 USD, and the direct cost per three trimesters was $1824-2115 USD. The average family income per month was $614.23 USD and the average health expenditure (per month) was 105.71 USD; which represents 16.21% of the family income. The average family health expenditure per trimester was $317.13 USD. Conclusion The total cost for prenatal care per trimester was calculated in $608 to 705 USD. The cost of prenatal care per trimester is 193.69% higher than the average health expenditure per trimester for uninsured women with ARDs. More and new strategies are needed to solve and reduce inequalities in access to health. Table 1. Average cost of prenatal care per trimester Medical consultations and ultrasounds Medical Consultations Costs (USD ) Frecuency COST PER TRIMESTER $184-277 USD Rheumatologist $13 Monthly Genetics $49 At least one Obtetrician $14 Monthly US 1st Trimester $54 Only one time US 2nd Trimester $49 Only one time Psychologist $39 If needed Nutritionist $5 If needed Clinical test Clinical test Costs (USD ) Frecuency COST PER TRIMESTER $188 USD Complete Blood Count $9 One per trimester Blood Chemistry $38 One per trimester Vitamin D (25-OH) $59 One per trimester Thyroid profile test $16 One per trimester PT, TTP $36 One per trimester Protein C reactive $20 One per trimester Erythrocyte sedimentation rate $5 One per trimester Urine general test $5 One per trimester Immune lab test (For patients with rheumatoid arthritis and spondylarthritis ) Immune lab test Costs (USD ) Frecuency COST PER TRIMESTER $240 USD Rheumatoid factor $24 One per trimester Anti-CCP $33 One per trimester Anti SS-A/RO $19 One per trimester Anti-SS-B/LA $19 One per trimester Anticardiolipins $33 One per trimester Beta-2-glycoprotein $66 One per trimester Lupus anticoagulant $46 One per trimester Immune lab test (For patients with lupus, antiphospholipid syndrome, Sjogren’s syndrome, vasculitis, and others ) (Others: rheumatic skin and muscle diseases, ) Immune lab test Costs (USD ) Frecuency COST PER TRIMESTER $236 USD Anti-SS-A/RO $21 One per trimester Anti-SS-B/LA $21 One per trimester Anticardiolipins $33 One per trimester Beta-2-glycoprotein $66 One per trimester Lupus anticoagulant $46 One per trimester Anti-DNA $24 One per trimester Antinuclear antibodies $25 One per trimester Disclosure of Interests None declared